OSFED Versus EDNOS: What is the Difference?


Eating Disorder Not Otherwise Specified (EDNOS) was a diagnosis from the DSM IV-which was utilized for individuals who had eating disorder symptomology and significant distress, but did not meet the full criteria for any of the other eating disorder diagnoses.

Additionally it is important to note that, EDNOS used to be the most commonly diagnosed eating disorder and encompassed a varied group of people. “Approximately 40-60% of cases in eating disorder treatment centers fell into the EDNOS category and about 75% of individuals with eating disorders seen at non-specialty community settings had EDNOS.”

The Diagnostic & Statistical Manual (DSM-IV) currently lists six clinical examples of EDNOS.

  1. All criteria for anorexia are met, however the individual’s weight falls within normal range (despite significant weight loss).
  2. All criteria for anorexia are met, however the individual has regular menstrual cycles.
  3. All criteria for bulimia are met, however purging or binge-eating episodes happen less than two times per week or for fewer than three months.
  4. Someone purges after eating a small amount of food and has a normal body weight.
  5. An individual repeatedly chews and spits large amounts of food.
  6. All of the criteria are met for binge eating disorder. 

Eating Disorders Are Serious Mental Illnesses

The diagnosis of EDNOS has not received as much media or public attention as other eating disorder diagnoses, such as anorexia and bulimia nervosa. Further, some individuals mistakenly believe that a diagnosis of EDNOS means that their eating disorder is not “as serious” as the more traditional diagnoses.

However, this is utterly false. All eating disorders are serious mental illnesses-which can be deadly if an individual does not receive appropriate treatment and support.

In fact, “Many studies have shown that individuals with the EDNOS diagnosis experience eating pathology and medical consequences that are just as, if not more, severe than individuals who receive a formal anorexia or bulimia diagnosis. Furthermore, one recent study found that 75% of individuals with EDNOS had co-occurring psychiatric disorders and 25% endorsed suicidality.”

Other Specified Feeding or Eating Disorder (OSFED)

In The DSM-6, the diagnosis of EDNOS was formally changed to Other Specified Feeding or Eating Disorder (OSFED). While OSFED has received less attention than other eating disorders, it is believed to be the most common with an estimated 32% to 53% of all individuals with eating disorders who have received the diagnosis.

According to The National Association of Anorexia Nervosa and Associated Disorders, the following are five subtypes of OSFED:

  1. Atypical Anorexia Nervosa: An individual has restrictive behaviors and other symptoms of anorexia, however they do not meet the low weight criteria.
  2. Bulimia Nervosa: An individual meets the criteria for bulimia but engages in binging or purging behaviors at a lower frequency and/or for a limited period of time.
  3. Binge Eating Disorder: An individual meets the criteria for binge eating disorder but engages in binging behaviors at a lower frequency and/or for a limited period of time. A person experiences episodes of eating, in a short period of time an amount of food that is larger than what most individuals would consume and feels out of control.
  4. Purging Disorder: Purging behaviors that may include vomiting, excessive exercise, laxatives, etc.
  5. Night Eating Syndrome: Recurrent episodes of night eating. The person recalls what they have eaten.

Risks Can Be Severe

Additionally, it is important to note that the risks associated with a diagnosis of OSFED can be severe. Despite the common misconception (as with the prior diagnosis of EDNOS) that OSFED is somehow “less serious” than other eating disorder diagnoses-“some previous studies show the mortality rate of EDNOS (now OSFED) as high as individuals who meet the thresholds for Anorexia.”

Denial of the severity of the illness is often a common component for those who are struggling with eating disorders. This can be even more challenging for individuals with an OSFED diagnosis, as their eating disorder voice may try to convince them that they are “not sick enough to need to seek treatment.”

However, this could not be further from the truth. Everyone who is struggling with an eating disorder deserves to seek treatment and OSFED carries many of the same risks as the other eating disorders.

If you or a loved one is struggling with OSFED, it is critical that you reach out to seek help and support from trained clinical professionals. No one chooses to have an eating disorder, but you can choose to begin working towards full recovery-at any time.